Acta Medica Lituanica最新文献

{"title":"An Anomalous Right Coronary Artery Originating from the Left Anterior Descending Artery, a Case Report of Successful Percutaneous Coronary Intervention.","authors":"Ebrahim Nematipour, Arash Shekari, Shapour Shirani, Seyyed Mojtaba Ghorashi","doi":"10.15388/Amed.2025.32.2.7","DOIUrl":"10.15388/Amed.2025.32.2.7","url":null,"abstract":"<p><strong>Background: </strong>An anomalous right coronary artery (RCA) originating from the left anterior descending artery (LAD) is a rare subtype of single coronary artery ostium. Revascularization in such cases is challenging due to the large feeding territory or the potential for compression by an adjacent vessel.</p><p><strong>Case description: </strong>We report the case of a 57-year-old woman who presented to our hospital with exertional chest pain and dyspnea. An anomalous RCA was identified, originating from the mid-portion of the LAD. Coronary angiography and coronary multi-detector computed tomography revealed a significant stenosis at the LAD just proximal to the RCA bifurcation. A successful percutaneous coronary intervention was performed to revascularize the LAD stenosis. The patient was discharged in good general condition two days later.</p><p><strong>Conclusions: </strong>Despite the rarity of coronary anomalies, future studies could be undertaken to assess the potential benefits of screening, particularly in specific populations such as professional athletes.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"377-383"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Run-Over Clinical Case. Evisceration of the Intestines through the Wrist.","authors":"Jekaterina Strelčenko, Diana Vasiljevaitė, Sigitas Chmieliauskas, Sigitas Laima, Jurgita Stasiūnienė, Paulius Petreikis","doi":"10.15388/Amed.2025.32.2.9","DOIUrl":"10.15388/Amed.2025.32.2.9","url":null,"abstract":"<p><strong>Background: </strong>Deaths resulting from car-pedestrian collisions are frequently encountered in forensic practice. Such accidents often cause extensive, multi-system injuries, many of which are concealed beneath minimally damaged soft tissues and may not be immediately visible externally. Common external injuries include extensive skin abrasions, subcutaneous hematomas, and lacerations. Internally, these incidents typically result in multiple bone fractures and severe organ ruptures. A less frequent but noteworthy injury is the evisceration of abdominal organs through ruptures in the diaphragm, rectum, or abdominal wall. This report presents a unique case of small intestine evisceration through damaged skin on the wrist.</p><p><strong>Materials and methods: </strong>The literature search was conducted in the <i>PubMed</i> and <i>Google Scholar</i> databases using keywords. The analysis focused on scientific literature that was published in last 10 years but also referred to older scientific papers with strong arguments. To the best of our knowledge, there are no reported cases of evisceration of abdominal contents through the damaged skin of the lower arm (wrist). A clinical case examination from the Lithuanian State Forensic Medicine Service data was performed.</p><p><strong>Case presentation: </strong>A 70-year-old woman was injured in the run-over accident by a truck. The victim died at the scene. External examination revealed multiple injuries, including significant soft tissue deformities in the left arm. During the internal examination of the corpse, multiple fractures with ruptures of internal organs were found. Only isolated fragments of intestinal loops were present in the abdominal cavity. Evisceration of the small intestines through the left upper arm and forearm was found.</p><p><strong>Conclusions: </strong>Run-over accidents involving heavy vehicles are a common cause of fatal injuries. These incidents often result in extensive lacerations, multiple comminated fractures, and severe damage to internal organs. In rare cases, evisceration of internal organs can occur through various anatomical sites. This case demonstrates that evisceration can occur not only through common locations such as the diaphragm, abdominal wall, rectum, or vagina but also through atypical sites, such as the skin of the wrist. In such cases, it is particularly important for a forensic pathologist to assess the damage of clothing and to evaluate the macromorphological appearance of the injuries to determine the mechanism of injury.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"384-392"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing Local Diagnostic Reference Levels and Reference Curves for Thorax and Abdomen-Pelvis Paediatric CT Procedures.","authors":"Rokas Dastikas, Antonio Jreije, Birutė Gricienė","doi":"10.15388/Amed.2025.32.1.12","DOIUrl":"10.15388/Amed.2025.32.1.12","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography is a highly informative diagnostic tool, but its use poses the challenge of managing potentially high radiation exposure to patients. Children are particularly vulnerable to the harmful effects of ionizing radiation, and the growing use of paediatric <i>Computed Tomography</i> (CT) scans has been linked to an elevated lifetime risk of cancer and an increased mortality. The aim of this study was to evaluate local radiation exposure doses in paediatric thoracic and abdominal-pelvic CT exams, to establish <i>Diagnostic Reference Level</i> (DRL) curves, propose local diagnostic reference levels, and compare them with the existing literature and the European Guidelines on Diagnostic Reference Levels for Paediatric Imaging (PiDRL).</p><p><strong>Materials and methods: </strong>A dataset of thoracic and abdominal-pelvic CT exams performed on children was analysed. Scan data entries were grouped according to the patient weight in the following intervals: 5 to 14 kg, 15 to 29 kg, 30 to 49 kg, and 50 to 79 kg. In each weight group, the minimum, first quartile, median, third quartile, and the maximum values of <i>Volumetric Computed Tomography Dose Index</i> (CTDI_vol) and the <i>Dose Length Product</i> (DLP) were calculated. The relationship between CTDI_vol, DLP, and the patient body weight was assessed by using exponential curves.</p><p><strong>Results: </strong>The local DRLs were established for thoracic CT exams, while, for abdominal-pelvic CT exams, the DRL curve was set as a substitute due to limited data. The proposed local DRL values for thoracic computed tomography examinations are 2.0, 2.4, 3.6, and 5.0 mGy for CTDI_vol and 40, 60, 116, and 156 mGy•cm for DLP in the corresponding weight groups of 5 to 14 kg, 15 to 29 kg, 30 to 49 kg, and 50 to 79 kg. The median values of CTDI_vol for paediatric abdominal-pelvic computed tomography were 2.8 mGy in the 5-to-14 kg weight group, 3.6 mGy in the 15-to-29 kg group, 4.8 mGy in the 30-to-49 kg group, and 7.9 in the 50-to-79 kg group. The median DLP values were 81, 127, 203, and 304 mGy•cm, respectively.</p><p><strong>Conclusions: </strong>The set local DRLs for thoracic and the median dose values in abdominal-pelvic CT exams are generally lower than the European DRLs. The derived DRL curves fulfil the same purpose as weight-group DRLs, serving as benchmarks for dose optimization.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 1","pages":"120-125"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Fibroadenoma to Phyllodes Tumor: Case Analysis of Borderline and Giant Breast Tumors with Literature Review.","authors":"Justė Kazlauskaitė, Iryna Schmeil","doi":"10.15388/Amed.2025.32.1.4","DOIUrl":"10.15388/Amed.2025.32.1.4","url":null,"abstract":"<p><strong>Background: </strong>Phyllodes tumors are highly uncommon fibroepithelial neoplasms of the breast, accounting for less than 1% of all breast tumors. Differential diagnosis between phyllodes tumors and fibroadenomas by using imaging techniques such as ultrasound or mammography, as well as histological methods, can be challenging due to overlapping features. Phyllodes tumors are categorized into benign, borderline, and malignant types, each posing a different risk of recurrence and metastasis. Despite many advances in the imaging and biopsy techniques, diagnosing phyllodes tumors remains challenging. The purpose of this study is to review the existing literature on this topic and describe two cases of misdiagnosed phyllodes tumors.</p><p><strong>Materials and methods: </strong>A literature review was conducted by using the <i>Medline</i> (<i>PubMed</i>) database over 10 years. Information concerning the patients was sourced from the Uster Hospital database. After analyzing the cases of women with breast lumps from 2020 to 2023 in the Uster Hospital database, two cases of misdiagnosed phyllodes tumors were identified. These two cases were analyzed retrospectively.</p><p><strong>Results: </strong>A retrospective study of two cases confirms that phyllodes tumors are a rare phenomenon. A 51-year-old premenopausal woman presented with an 8 × 4 × 5 cm mass, initially diagnosed as a fibroadenoma. The final histopathology after surgical excision revealed a borderline phyllodes tumor with features overlapping those of a fibroadenoma. The second case involved a 59-year-old postmenopausal woman with a rapidly growing mass, which reached 11.9 × 11.3 cm and was initially diagnosed as a fibroadenoma but later confirmed as a borderline malignant phyllodes tumor with focal malignant components. Both cases highlight the limitations of imaging and core biopsy in accurately diagnosing phyllodes tumors and emphasize the need for comprehensive histopathological evaluation. The described clinical cases corresponded to the characteristics of phyllodes tumors indicated in the literature: they appeared in women older than 35 years, were hard to distinguish from fibroadenomas, and required surgical treatment.</p><p><strong>Conclusions: </strong>Phyllodes tumors are challenging to distinguish from fibroadenomas based on imaging and the initial biopsy results alone. Accurate diagnosis requires thorough histopathological examination following surgical excision. A multidisciplinary approach is essential for optimal management. Our cases show the complexity of phyllodes tumor diagnosis and the importance of considering phyllodes tumors in the differential diagnosis of breast masses, especially when clinical and imaging findings suggest a more aggressive pathology.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 1","pages":"190-205"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic Obturator Hernia with Ureter as Content: Case Report.","authors":"Alamelu Alagappan, Sambit Tripathy, Biswajit Sahoo, Debabrata Sahani, Manoj Kumar Nayak","doi":"10.15388/Amed.2025.32.1.9","DOIUrl":"10.15388/Amed.2025.32.1.9","url":null,"abstract":"<p><p>A male in his early 70s presented with complaints of bilateral flank pain for seven months, hematuria for 2 days along with the passage of clots associated with an increased frequency of urination and nocturia. The patient had a history of deep vein thrombosis and was on anticoagulation. On ultrasound, multiple calculi with posterior acoustic shadowing were seen in bilateral kidneys, corroborated by <i>Computed Tomography</i> (CT) urography. Laser lithotripsy with DJ stent placement was conducted. The follow-up CT urography showed an inferiorly displaced DJ stent within the right distal ureter and the DJ stent herniating through the right obturator foramen. The right-sided DJ stent was removed after a month. For obturator hernia, the patient is being kept in the follow-up. This case report reviewed the literature and discussed the diagnosis and complications associated with the obturator hernia with the ureter as the content.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 1","pages":"249-252"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nodal Marginal Zone Lymphoma with Simultaneous Transformation at Diagnosis and Pleural Effusion as the Initial Presentation: A Case Report.","authors":"Konstantinos Dodos, Vasileia Tsampika Kalamara, Vasiliki Epameinondas Georgakopoulou, Paraskevi Kavoura","doi":"10.15388/Amed.2025.32.1.21","DOIUrl":"10.15388/Amed.2025.32.1.21","url":null,"abstract":"<p><p>Nodal Marginal Zone Lymphoma (NMZL) is a rare, indolent subtype of B-cell non-Hodgkin lymphoma. This case report presents a 67-year-old female diagnosed with NMZL, which had transformed into Diffuse Large B-cell Lymphoma (DLBCL) at the time of diagnosis. The patient's initial presentation involved a dry cough and pleural effusion, a symptom rarely reported in NMZL cases. Diagnostic procedures, including cytology and immunohistochemistry, confirmed the presence of monoclonal B lymphocytes and identified markers consistent with NMZL transformation to DLBCL. The findings highlight the diagnostic challenges associated with NMZL due to the lack of specific immunohistochemical markers, emphasizing the need for histopathological analysis to distinguish NMZL from other lymphomas, such as follicular lymphoma. This case underscores the importance of early detection and differentiation in lymphomas presenting with pleural effusion, as transformation to aggressive forms like DLBCL significantly impacts the prognosis and treatment approaches. Despite the rarity of transformation at diagnosis, clinicians must consider it in NMZL cases with atypical presentations.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 1","pages":"210-211"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological Versus Synthetic Grafts in ACL Reconstruction: A Comparative Analysis of Failure Rates, Knee Stability, and Functional Outcomes.","authors":"Karolis Strašunskas, Rokas Jurkonis","doi":"10.15388/Amed.2025.32.2.13","DOIUrl":"10.15388/Amed.2025.32.2.13","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament (ACL) injuries are among the most common and impactful musculoskeletal injuries, particularly in athletic populations. A variety of biological and synthetic grafts are used in surgical reconstruction, each offering different biomechanical properties and long-term outcomes.</p><p><strong>Materials and methods: </strong>This narrative review analyzed 42 original clinical studies published between 1989 and 2024. Articles were retrieved from <i>PubMed</i> and <i>Google Scholar</i> by using terms such as 'ACL reconstruction', 'BPTB', 'hamstring tendon', 'quadriceps tendon', 'LARS', 'Leeds-Keio', and 'GORE-TEX'. Key outcomes included graft failure rates, postoperative knee stability (e.g., KT-1000, Lachman test), and functional outcomes (Lysholm, Tegner, IKDC). Numerical data were pooled descriptively; no formal meta-analysis was performed.</p><p><strong>Results: </strong>Biological grafts, particularly BPTB and quadriceps tendon autografts, demonstrated the lowest failure rates (as low as 1.2%) and superior mechanical stability (>95% achieving Grade 0-1 laxity) compared to synthetic options. Hamstring tendon autografts were slightly less durable but still reliable. Synthetic grafts, and especially GORE-TEX and Leeds-Keio, were associated with higher failure rates (up to 33%) and complications related to poor biological integration.</p><p><strong>Conclusions: </strong>BPTB and QT autografts remain the most reliable options for ACL reconstruction, offering excellent long-term outcomes. While synthetic grafts may be appropriate in select patients, they carry a higher risk of failure and complications. Graft selection should be individualized based on the patient activity level, anatomical considerations, and tolerance for donor-site morbidity.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"267-288"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency of Microwave Ablation for Cortisol-Producing Adrenal Adenomas: Case Series and a Literature Review.","authors":"Alicija Krasavceva, Juozas Jarašūnas, Donatas Jocius, Romena Laukienė, Žydrūnė Visockienė, Virgilijus Beiša","doi":"10.15388/Amed.2025.32.2.5","DOIUrl":"10.15388/Amed.2025.32.2.5","url":null,"abstract":"<p><strong>Background: </strong>Adrenal adenomas, often discovered during imaging studies for unrelated conditions, pose diagnostic and therapeutic challenges due to their varying presentations and potential for hormone secretion. While surgical management remains the standard approach for hormonally active adrenal tumors, percutaneous ablation techniques - such as microwave ablation - have emerged as promising alternatives, particularly for patients who are not candidates for surgery.</p><p><strong>Materials and methods: </strong>This report presents a series of clinical cases in which percutaneous microwave ablation was used as an alternative to adrenalectomy. The study focuses on patients with cortisol-producing adrenal adenomas and explores the effectiveness of this minimally invasive procedure in achieving hormonal control and symptom relief.</p><p><strong>Results: </strong>Microwave ablation was successfully performed in all cases without major complications. Clinical follow-up demonstrated improvement in cortisol levels and relief of symptoms related to hypercortisolism. The procedure was well tolerated, offering an alternative therapeutic option for patients unsuitable for adrenalectomy.</p><p><strong>Conclusions: </strong>Percutaneous microwave ablation may serve as a safe and effective treatment option for cortisol-secreting adrenal adenomas in patients with Mild Autonomous Cortisol Secretion and ACTH-independent Cushing Syndrome who are not candidates for surgery. This approach may provide significant symptom relief and hormonal control with minimal invasiveness.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"356-368"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Descending Thoracic Aortic Aneurysm: A Case Report.","authors":"Rassul Zhumagaliyev, Yerlan Orazymbetov, Serik Aitaliyev, Sidar Arslan, Tadas Lenkutis, Adakrius Siudikas, Rimantas Benetis","doi":"10.15388/Amed.2025.32.2.14","DOIUrl":"10.15388/Amed.2025.32.2.14","url":null,"abstract":"<p><strong>Background: </strong>Giant descending thoracic aortic aneurysm (GDTAA) is a rare vascular disease characterized by an aortic diameter exceeding 10 cm. GDTAA carries a significant risk of rupture and mortality and requires timely diagnosis and intervention. Despite the clinical severity of the disease, the literature on GDTAA remains sparse, particularly in cases with extreme aneurysmal dilatation.</p><p><strong>Case presentation: </strong>We present the case of a 68-year-old man with a GDTAA of 14.08 × 10.04 cm, one of the largest ever reported. The patient initially presented with recurrent syncope, chronic cough and fatigue. Imaging studies, including <i>Computed Tomography</i> (CT) angiography, revealed a massive aneurysmal dilatation in the distal post-arch segment of the descending aorta with compression of the trachea and bronchi. The patient underwent a successful open surgical repair with a Dacron graft and simultaneous <i>Coronary Artery Bypass Grafting</i> (CABG). Postoperative complications included respiratory acidosis, emphysema and transient haemodynamic instability, which were effectively treated. The patient was discharged in a stable condition on the tenth postoperative day.</p><p><strong>Conclusion: </strong>This case highlights the importance of early recognition and surgical intervention in GDTAA in order to prevent catastrophic consequences. Comprehensive preoperative evaluation, careful surgical planning and attentive postoperative care are essential for optimal recovery. Our results emphasise the importance of modern imaging techniques for accurate anatomical assessment and risk stratification in patients with extreme aneurysm growth. Further research is needed to establish standardised protocols for the treatment of GDTAA.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"413-423"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathomorphological Patterns of Placental Dysfunction in Late Manifestation of Fetal Growth Restriction.","authors":"Oksana Zhurakivska, Yuliia Yarotska, Dmytro Govsieiev, Oksana Ostrovska, Mariana Rymarchuk","doi":"10.15388/Amed.2025.32.2.21","DOIUrl":"10.15388/Amed.2025.32.2.21","url":null,"abstract":"<p><p>Fetal growth restriction is one of the main factors contributing to neonatal mortality, stillbirth, and cardiovascular dysfunction in a fetus and newborn, where one of the common causes is placental dysfunction; it can occur as a result of placental vascular anomalies, which requires clarification and systematization of existing scientific provisions based on the assessment of morphological patterns of fetoplacental circulatory disorders. The aim of the study was to investigate and evaluate morphological markers of fetoplacental blood flow disorders in late manifestation of fetal growth restriction by pathohistological examination of placental tissue.</p><p><strong>Materials and methods: </strong>Clinical and anamnestic features were assessed in 80 pregnant women with late manifestation of fetal growth restriction (the main group of research) and in 40 patients with a timely labour and birth of fetuses with normal fetometry parameters for the gestational age. 32 and 10 placental tissue samples were selected in the main group and in the comparison group, respectively, for pathohistological examination, and a postnatal macro-histomorphological assessment of the placenta was performed.</p><p><strong>Results: </strong>Postnatal macromorphometric characteristics of placental tissue reflect pathological features of its formation, dominated by an abnormal shape (46-57.5%), eccentric umbilical cord insertion (43-53.8%) with main and intermediate types of vascular branching (37-46.2%), and a statistically lower placental weight and diameter. A combination of maternal and fetal vascular malperfusion was noted, with the following most significant markers: infarctions (13-40.6%), distal villous hypoplasia (24-75.0%), increased syncytial nodules as a manifestation of delayed villous maturation as a manifestation of premature maturation (24-75.0%), decidual arteriopathy (13-40.6%). Analysis of histopathological data indicates malperfusion of the fetal vessels, with the proportion of villitis and markers of intrauterine infection verified in one third of the samples (13-40.6%).</p><p><strong>Conclusions: </strong>In cases of late-onset fetal growth restriction, placental lesions occur with the development of maternal and fetal vascular malperfusion. Pathomorphological criteria of maternal vascular malperfusion are statistically significant in the main group: infarctions, distal villous hypoplasia, decidual arteriopathy, and chorionic villous dysmaturation. Fetal vascular malperfusion is characterized by obliteration and thrombosis of the stem vessels of the anchoring and intermediate villi, avascularization, hyalinosis of the villi, and, less frequently, delayed maturation with the development of stromal-vascular karyorexis. In our study, both Type 1 and Type 2 fetal vascular malperfusion in different placentas with fetal growth restriction were found, but the segmental type was still the most common.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"301-312"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}